ProAir vs. Xopenex
See how ProAir and Xopenex compare on approved uses, dosing, side effects, and cost.
Key Takeaways
ProAir and Xopenex are both short-acting bronchodilators used to relieve or prevent asthma-related bronchospasm, but they differ in formulation and delivery options.
ProAir is FDA-approved for exercise-induced bronchospasm prevention and comes only as a metered-dose inhaler with a built-in dose counter.
Xopenex delivers the single R-isomer of albuterol and is available as both a nebulizer solution and an HFA inhaler, offering more dosing flexibility for some patients.
ProAir vs. Xopenex Drug Summary
ProAir
ProAir (albuterol sulfate) is a short-acting beta2-agonist inhaler used to treat and prevent bronchospasm in asthma and other reversible airway diseases. It is taken as 1 to 2 inhalations from a metered-dose inhaler, either as needed for symptoms or before exercise to prevent bronchospasm.
Xopenex
Xopenex (levalbuterol) is a short-acting beta2-agonist bronchodilator used to treat and prevent bronchospasm in reversible airway disease. It is delivered either through a nebulizer solution three times daily or through an HFA inhaler used every four to six hours.
ProAir vs. Xopenex Side Effects
ProAir
Xopenex
ProAir vs. Xopenex Dosage
ProAir
Xopenex
| STAGE | DOSE | WHEN |
| Starting dose | 2 inhalations every 4-6h | At the start |
| Maximum dose | 2 inhalations pre-exercise | If needed |
| Dose changes | 2 increases | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 0.31 mg three times daily | At the start |
| Maximum dose | 90 mcg (2 inh) q4-6h | If needed |
| Dose changes | 4 increases | As tolerated |
ProAir
| STAGE | DOSE | WHEN |
| Starting dose | 2 inhalations every 4-6h | At the start |
| Maximum dose | 2 inhalations pre-exercise | If needed |
| Dose changes | 2 increases | As tolerated |
Xopenex
| STAGE | DOSE | WHEN |
| Starting dose | 0.31 mg three times daily | At the start |
| Maximum dose | 90 mcg (2 inh) q4-6h | If needed |
| Dose changes | 4 increases | As tolerated |
ProAir vs. Xopenex Indications
ProAir
ProAir is FDA-approved to treat or prevent bronchospasm in people 4 and older with reversible obstructive airway disease, including asthma. It is also approved to prevent exercise-induced bronchospasm in the same age group.
Treats bronchospasm from asthma or COPD
Prevents exercise-induced bronchospasm
Approved for ages 4 and up
Fast-acting rescue relief within minutes
Xopenex
Xopenex is FDA-approved to treat or prevent bronchospasm caused by reversible obstructive airway disease. It is available as a nebulizer solution and as an HFA inhaler, giving clinicians flexibility in how it's delivered to different patients.
Treats bronchospasm from asthma or COPD
Available as nebulizer solution or inhaler
Single-isomer (R-enantiomer) of albuterol
Not specifically labeled for exercise-induced bronchospasm
ProAir vs. Xopenex Pros and Cons
ProAir
ProAir is a well-established albuterol inhaler with decades of real-world use and an FDA label that explicitly covers exercise-induced bronchospasm. Its authorized generic status has made it a common first-choice rescue inhaler across most insurance formularies.
Pros
FDA-approved specifically to prevent exercise-induced bronchospasm
Approved for children as young as 4
Includes a built-in dose counter so patients know when to refill
Cons
Only available as a handheld inhaler, no nebulizer solution option
Contains both R- and S-albuterol isomers, unlike Xopenex's single-isomer formula
Fewer FDA-listed dosing regimens than Xopenex
Xopenex
Xopenex offers levalbuterol, the single active isomer of albuterol, in both nebulizer and inhaler forms. This gives clinicians more flexibility in delivery method and dose strength, though its label doesn't specifically address exercise-induced bronchospasm.
Pros
Single-isomer (R-enantiomer) formulation, which some patients tolerate better than racemic albuterol
Offered as both a nebulizer solution and an HFA inhaler
Multiple approved dosing strengths (0.31 mg, 0.63 mg, 1.25 mg) allow individualized dosing
Cons
Not specifically FDA-approved for exercise-induced bronchospasm prevention
No stated minimum age in its FDA label, requiring clinician judgment for pediatric use
Nebulizer dosing requires three-times-daily administration, less convenient than as-needed inhaler use
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